Marathon Training: How to Prevent Injuries and Perform at Your Best

Why Injury Prevention Matters During Marathon Training

Training for a marathon or half marathon isn’t just about adding more miles. It’s about making sure your body can handle those miles without breaking down halfway through your training plan.

From a physiotherapy perspective, most running injuries aren’t caused by one dramatic moment. They’re the result of small overloads building up over time. Research shows that around 60–80% of runners sustain an injury each year, with the most common problems including knee pain, Achilles tendinopathy, shin splints and plantar fasciitis.

More often than not, the cause comes down to one simple issue: doing a bit too much, too soon, too often. That’s where progressive overload becomes essential. Increase your training gradually and your body adapts. Rush the process, and something usually starts to niggle.

Strength Training: The Missing Piece for Many Runners

One of the biggest mistakes we see in clinic is runners skipping strength training. It’s often treated as an optional extra, when in reality it’s one of the most effective ways to stay injury-free and improve running performance.

Running is highly repetitive, involving thousands of strides that place stress through the same muscles, tendons, and joints. Over time, even small weaknesses become exposed.

Strength training - particularly single-leg exercises such as split squats, lunges, and step-ups - helps improve resilience, stability, and movement control. Just as importantly, these exercises reveal left-to-right strength differences.

These imbalances matter. Research suggests that strength differences greater than 10-15% significantly increase injury risk. When one side isn't contributing equally, the other side compensates, altering running mechanics and placing excessive stress on tissues. Over time, this can lead to issues such as knee pain, calf strains, or Achilles problems.

Recovery: Where Fitness Actually Happens

Many runners think the hard work happens during the run. In reality, the adaptations happen afterwards.

Recovery is when your body repairs damaged tissue, becomes stronger, and prepares for the next training session. Without sufficient recovery, that process is compromised, increasing the likelihood of injury.

Key areas to prioritise include:

• Getting adequate sleep

• Eating enough to support training

• Scheduling regular recovery days

• Managing overall training load

How Sports Massage Can Help

Sports massage can be a valuable addition to a marathon training programme.

Evidence suggests it can help reduce delayed onset muscle soreness (DOMS) while improving perceived recovery. Physiologically, it may help improve circulation, reduce muscle stiffness, and encourage the nervous system to shift into a more relaxed, recovery-focused state.

In practice, many runners report feeling less tight, moving more freely, and coping better with heavy training blocks.

While sports massage shouldn't replace good recovery habits, it can be an excellent support tool during high-volume training and in the days following race day.

Fuelling Your Body for Marathon Success

Nutrition is another factor that can make or break your marathon training.

From a physiotherapy perspective, under-fuelling is a major concern. Low energy availability has been linked to an increased risk of injuries—particularly bone stress injuries—as well as slower recovery and poorer performance.

Carbohydrates remain your body's primary fuel source. During heavier training weeks, insufficient carbohydrate intake can lead to fatigue, poor-quality training sessions, and delayed recovery.

Hydration is equally important. On longer runs, losing fluids and electrolytes affects muscle function and reduces your body's ability to tolerate training load.

Race Day Nutrition

As race day approaches, fuelling becomes even more important.

Carbohydrate loading in the days before your event helps ensure you begin with full glycogen stores. During the race itself, consuming approximately 60-90 grams of carbohydrates per hour has been shown to improve endurance performance and delay fatigue.

However, your race-day nutrition strategy should never be a surprise. Every gel, drink, or fuelling plan should be tested during training long before race day arrives.

Recovering Properly After Race Day

Crossing the finish line isn't the end of the process; it marks the beginning of recovery.

Following a marathon, your body experiences significant physiological stress. Muscle damage markers are elevated, strength is temporarily reduced, and fatigue affects multiple systems.

During the first 24-48 hours, your priorities should be:

• Refuelling

• Rehydrating

• Gentle movement

• Rest

Over the following days, focus on quality sleep, light mobility work and a gradual return to activity.

Sports massage may help reduce post-race stiffness and improve comfort during recovery, but allowing your body sufficient time to repair remains the priority.

One of the most common mistakes runners make is returning to training too quickly, increasing the likelihood of post-race injuries.

Recovery isn't simply about feeling better - it's about restoring your body's capacity to train well again.

How We Support Marathon and Half Marathon Runners

At Carter & George, we work with runners throughout every stage of their training - from building base mileage to tapering before race day.

Our focus is helping runners stay consistent because consistency is what drives both performance improvements and injury prevention.

Sports massage is often incorporated alongside marathon training blocks to reduce muscle tightness, improve recovery between sessions, and help runners continue training without constantly battling minor injuries.

Strength training also forms a key part of our approach. The aim isn't to turn runners into weightlifters - it’s to ensure the body can tolerate repetitive running loads. Our programmes focus on improving single-leg strength, increasing load capacity and correcting the small asymmetries that often become problematic as fatigue accumulates.

Injury Prevention Screening: Identifying Problems Before They Start

One of the most valuable services we offer runners is a comprehensive injury prevention and performance screening. Rather than waiting for pain to develop, this assessment identifies areas of weakness before they become injuries.

We assess:

• Running movement patterns

• Side-to-side strength and mobility

• Single-leg stability

• Control under fatigue

These findings are compared against expected benchmarks for efficient, resilient running.

The result is a clear, practical report highlighting strengths, identifying compensations, and providing straightforward recommendations to reduce injury risk and improve performance throughout training.

Expert Care for Complex Running Injuries

For more complex or persistent injuries, we work closely with Sports and Exercise Medicine (SEM) consultants as part of a collaborative team.

This multidisciplinary approach provides access to advanced medical expertise and diagnostic tools, including musculoskeletal ultrasound where appropriate, allowing us to refine diagnoses and tailor rehabilitation more effectively.

In some cases, ultrasound-guided injections may also be considered to reduce symptoms and support rehabilitation when clinically appropriate.

Working together ensures runners receive seamless care from diagnosis through rehabilitation and back to full training.

A Complete Approach to Marathon Performance

When these elements come together, they create what we consider gold-standard care.

It's not simply about treating injuries once they occur. It's about identifying risks early, addressing weaknesses, improving resilience, and helping runners train consistently with confidence.

Final Thoughts

Marathon training isn't just about running more miles. It's about building strength, recovering properly, fuelling your body effectively, and managing training load so your body can keep up with your ambitions.

From a physiotherapy perspective, the goal is simple: reduce injury risk, improve performance and make sure you arrive on the start line feeling prepared - not just to complete the race, but to run it well.

Whether you're preparing for your first half marathon or chasing a marathon personal best, investing in injury prevention throughout your training will give you the best chance of reaching the finish line healthy, strong, and performing at your full potential.

Written by Kamie Lowe, Lead Physiotherapist at Carter & George Amersham.